Abstract
Topic Significance & Study Purpose/Background/Rationale Two chemotherapeutic agents used in blood and marrow transplant (BMT) conditioning regimens, melphalan and busulfan, are known for their high rates of oral mucositis (OM). While there is extensive literature on the effects of oral cryotherapy (OC) with melphalan, there is limited literature on its effects with busulfan. The aim of this study was to determine if OC decreases busulfan-associated OM. The secondary aim of this study was to look at the effects OC with busulfan had on length of stay (LOS), intensive care unit (ICU) transfer for airway protection, total parenteral nutrition (TPN) use, and opioid use for OM. Methods, Intervention, & Analysis Our center began using OC with busulfan infusions in January 2017. OC consists of patients continuously swirling ice chips and/or popsicles in their mouth, as well as swallowing ice cold water every 10-20 minutes, for two hours during busulfan infusions. This descriptive study utilized a retrospective/prospective electronic medical record review of patients receiving busulfan. Patients conditioned for allogeneic transplant using fludarabine along with either two or four days of busulfan were included in this purposive sample. This study compared outcomes among patient groups for two years before (N = 89) and two years after (N = 88) implementing OC. Findings & Interpretation OM severity was measured using the World Health Organization (WHO) OM scale. Between pre- and post-OC, this study found a decrease in WHO scores of 3 (severe) (37 vs 27) and 4 (life-threatening) (17 vs 5) along with an increase in scores of 0 (8 vs 16), 1 (mild) (17 vs 22), and 2 (moderate) (10 vs 18) (p Discussion & Implications These findings suggest that OC with busulfan is effective in reducing the severity of OM. OC is a low cost, nursing driven, easily implemented intervention which shows benefit in decreasing OM severity, LOS, ICU transfers for airway protection, TPN use, and opioid use for OM. These decreases translate into cost savings for both patients and organizations.
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